Varies by plan
Does Elevance Health (Anthem) require prior authorization for Premarin?
Prior authorization for Premarin differs across Elevance Health (Anthem)'s Medicare Part D plans and product strengths — 6 of 6 Premarin products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.
Some plans require authorization and others do not. The member's specific plan decides.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| estrogens, conjugated (USP) 0.625 MG Oral Tablet [Premarin]150840 | 65 / 67 | 65 | 0 | 0 | Prior authorization required |
| estrogens, conjugated (USP) 1.25 MG Oral Tablet [Premarin]202301 | 65 / 67 | 65 | 0 | 0 | Prior authorization required |
| estrogens, conjugated (USP) 0.3 MG Oral Tablet [Premarin]208513 | 65 / 67 | 65 | 0 | 0 | Prior authorization required |
| estrogens, conjugated (USP) 0.9 MG Oral Tablet [Premarin]208949 | 65 / 67 | 65 | 0 | 0 | Prior authorization required |
| estrogens, conjugated (USP) 0.45 MG Oral Tablet [Premarin]404550 | 65 / 67 | 65 | 0 | 0 | Prior authorization required |
| estrogens, conjugated (USP) 0.625 MG/ML Vaginal Cream [Premarin]688242 | 65 / 67 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — estrogens, conjugated (USP) 0.625 MG Oral Tablet [Premarin]
Premarin has 6 products in the corpus; this table is for estrogens, conjugated (USP) 0.625 MG Oral Tablet [Premarin], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-037 | 3 | Yes | No | No |
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-056 | 3 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H0629-002 | 3 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H4694-002 | 3 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H5854-020 | 3 | Yes | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2441-001 | 3 | Yes | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2836-007 | 3 | Yes | No | No |
| Anthem Extra Help (HMO-POS) | H3447-024 | 3 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H0629-001 | 3 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H3447-018 | 3 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H4694-004 | 3 | Yes | No | No |
| Anthem Full Dual Advantage (PPO D-SNP) | H2836-006 | 3 | Yes | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H3447-053 | 3 | Yes | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H4694-001 | 3 | Yes | No | No |
| Anthem Full Dual Advantage Select (HMO D-SNP) | H5854-013 | 3 | Yes | No | No |
| Anthem Full Dual Advantage Support (HMO D-SNP) | H4694-003 | 3 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage (HMO D-SNP) | H8432-042 | 3 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) | H8432-041 | 3 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) | H6988-004 | 3 | Yes | No | No |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | H0629-003 | 3 | Yes | No | No |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | H0629-004 | 3 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H3447-033 | 3 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H5854-012 | 3 | Yes | No | No |
| Anthem Kidney Care (PPO C-SNP) | H8552-028 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-013 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H8432-040 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H8432-009 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H8432-010 | 4 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H8432-011 | 4 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4036-026 | 3 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4036-036 | 3 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4909-014 | 3 | Yes | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-014 | 3 | Yes | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-016 | 3 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H3447-025 | 3 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-006 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-009 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-010 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H7220-004 | 3 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H8432-016 | 4 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H1607-015 | 3 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4036-030 | 3 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4909-026 | 3 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-049 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-050 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-051 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-052 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H6988-007 | 4 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 3 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 3 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H1607-012 | 3 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-008 | 3 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-025 | 3 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-034 | 3 | Yes | No | No |
| Anthem Medicare Advantage 4 (HMO-POS) | H3447-039 | 3 | Yes | No | No |
| Anthem Medicare Advantage 4 (HMO) | H7220-010 | 3 | Yes | No | No |
| Anthem Medicare Advantage 4 (PPO) | H4036-017 | 3 | Yes | No | No |
Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Premarin at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.